Questions for Discussion:

Given his history and PE, what do you estimate his likelihood of having
significant coronary artery disease to be? Answer

Using the Framingham data, what do you estimate his likelihood of a
coronary event to be in the next ten years? Answer

What additional studies or laboratory values would you like to further
evaluate his condition? Answer

You check a fasting lipid profile: TG 360, LDL 180, HDL 30, total chol
240
His 12-lead EKG from clinic is on the following page. You speak with him
again over the phone the next day to tell him the results as well as
schedule a stress EKG. Nevertheless, the patient does not follow up with
you.

Approximately 6 months later, you pass by Mr. Jo as he is being wheeled to
the coronary catheterization lab. He has O2 via face mask on, and the nurse
tells you that he had crushing substernal chest pain and diaphoresis
approximately 1 hour ago while shoveling snow. His initial cardiac enzymes
are as follows: myoglobin 1200 (high), CK 160 (nl), and troponin .1 (<.1 is
nl).

(His 12-lead EKG is included in your hand-out).

Define his clinical condition. What is the World Health Organization’s
definition of an acute myocardial infarction? Answer

Mr. JO is in the cath lab approximately 30 minutes after presenting to
the ER. He had two stents placed in his left anterior descending artery. (Do
any of the angiograms that were included correspond to his pathology? If so,
which one?)

You see him the following day. He is well. He slept OK overnight, and he is
planning on being discharged.